2. .Identify factors affect or alter mobility 
Describe the impact of immobility on physiologic and 
.psychological functioning
Discuss appropriate subjective and objective data to collect 
.to assess mobility status
Demonstrate nursing interventions, such as positioning, 
ambulating, providing range of motion, and using assistive
.devices
Plan strategies to avoid musculoskeletal injury to the 
.nurse and client during client care

3. The musculoskeletal system is the 
.supposing framework for the body
The bones and muscles are involved 
in movement and are responsible for
. the body's form and shape
Central and peripheral nerves 
coordinate the complex activity of
movement posture and balance
against the force of gravity requires
smooth, joints, and nerves and a
.stable center of gravity

4. Carrying out coordinated
movement is a complex
.process
Even with a framework of bones
held together by ligaments and
covered with soft tissue and
skin, normal function cannot
occur without coordinated
muscle activity and
.neurological integration

5. Nervous Systems Control
Normal mobility requires the
smooth control of movement
provided by the nervous system
.
Any disorder that impairs the
ability of the nervous systems to
control muscular movement and
coordination hinders functional
mobility

6. :Circulation and Oxygenation 
The skeletal muscles need adequate 
amounts of oxygen to function
. optimally
The lungs must provide oxygen to the 
hemoglobin while removing carbon
dioxide, the byproduct of aerobic
. metabolism in the muscles

7. The heart must adequately pump blood
to the muscles and supply other body
organs with enough blood to meet
the increased demands imposed by
. exercise
Many chronic disorders limit the supply
of oxygen and nutrients needed for
muscle contraction and movement
such as congestive heart failure or
.peripheral vascular disease

8. :Energy 
Energy for muscle function is derived 
from using oxygen and the
breakdown products of food to
.produce muscle contraction
Any conditions that strain nutritional 
stores deplete energy necessary for
. movement

9. :Congenital problems
Some conditions such as bifida or
cerebral palsy, are present at birth
. cannot be cured
Treatment goals are maximal functional
.mobility and minimal complications

10. :Affective Disorders 
Severe affective disorders can hinder
. mobility
Depression and catatonic states result in
limited mobility, not because of physical
impairments but because the person
. lacks the desire to move
Fear, especially of pain on movement,
may cause some people to restrict their
.movements as well

11. :Therapeutic Modalities 
Sometimes, limited movement is the 
.treatment of medical problems
Restrictive devices, such as casts, 
braces, and splints can immobilize
certain areas of the body to promote
. healing
Bed rest is another treatment 
whereby motility is restricted for
.therapeutic benefits

12. To promote healing and tissues repair by
.decreasing metabolic needs
.To relive edema
.To reduce the body oxygen requirements
.To decrease pain
To support a weak ,exhausted, or febrile
.client

14. Decreased muscle strength and
tone
Disused may be accompanied by
muscles atrophy, which is a
.decrease in muscles size
Decrease in muscle strength may
be so sever that the client can
.not support his body weight

15. Lack of Coordination 
Lack of coordination occurs 
when neurological control and
regulation of movement are
.impaired

16. Ataxia: is a general term used to 
.describe defective muscle coordination
Tremor : is a rhythmic repetitive 
movement that can occur at rest or
when movement is initiated. A tremor
usually interferes with fine motor
control, but in Parkinson's disease it
also can interfere with coordinated
. ambulation

17. Chorea: is spontaneous brief, involuntary
muscle twitching of the limbs or facial
muscles; severe chorea hinders
.mobility
Athetosis: is movement characterized by
.slow, irregular, twisting motions
Dystonia: is similar to athetosis but
usually involves larger areas of the
.body

18. Altered Gait 
Abnormal gait can affect the rhythm. 
steadiness, or speed of walking
An ataxic gait is characterized by 
.staggering and unsteadiness

19. Decreased Joint Flexibility 
Decreased joint flexibility typically occurs with 
altered mobility because decreased movement
. causes joints to stiffenss
Normal ROM decreases, because fibrosis and 
. fixation affect the joint structures
Muscles atrophy when they do not regularly 
shorten and lengthen during normal muscle
contraction. Initially, decreased flexibility and
altered ROM occur in affected joints, but if the
joints remain immobilized, contractures can
. occur
A contracture: is the progressive shortening of 
a muscle and loss of joint mobility resulting
from fibrotic changes in the tissues

20. Pain on movement 
Impaired mobility is often caused or 
. accompanied by pain on movement
Pain can result from physical injury, as 
in sprains, strains, or torn ligaments, or
it may result from degenerative and
. inflammatory processes
Osteoarthritis (degeneration of the 
articular surface of weight-bearing
joints) and rheumatoid arthritis (an
inflammatory disorder that affects
joints) are two common disorders that
limit mobility secondary to discomfort/

21. Activity Intolerance 
Decreased ability to tolerate activity 
. often accompanies impaired mobility
Activity intolerance :is the state in 
which the person has inadequate
physiologic or psychological energy to
. endure or to complete an activity
A balance must occur between the 
. activity and the client's energy
Symptoms associated with activity 
intolerance are dyspnea, tachycardia,
.discomfort, weakness, and fatigue

22. . Disuse Osteoporosis 
Immobility results in an imbalance 
between osteoblastic and osteoclastic
activity, because normal stress and strain
imposed on bone through movement are an
. important part of osteoblastic processes
In the immobilized client, osteoblasts 
continue to lay down bony matrix, but
osteoclasts, break down bone faster than
osteoblasts can build it. The result is a loss
. of bony matrix
Disuse osteoporosis results in bones that 
are more porous, brittle, and susceptible to
.fractures

23. Increased Cardiac Workload 
Cardiac workload is increased in the 
immobilized client because the heart
must work harder when the body is
. supine than when it is erect

24. Orthostatic Hypotension 
Orthostatic hypotension is the deceased 
ability to maintain systemic blood
pressure when changing from a supine to
. an upright position
Immobility decreases the effectiveness 
. of neurovascular reflex
During inactivity, regulatory adjustments 
. are not used and become inactive

25. Sympathetic stimulation may still occur 
in response to standing up right, but
peripheral vessels do not respond to
this stimulation. Therefore,
vasoconstriction does not occur, and a
.drop in blood pressure results
Another factor that may contribute to 
orthostatic hypotension is the
ineffectiveness of the muscle pump in
promoting venous return. This is
especially true of muscles atrophied by
. immobility

26. : Thrombus Formation and Embolism 
A thrombus is a blood clot composed of 
platelets, fibrin, and cellular elements that
. attaches to the wall of an artery or vein
A thrombus most commonly originates in 
the large veins of the legs because of the
.relatively low velocity of blood flow there
This condition is called deep vein 
(. thrombosis (DVT
When the clot breaks away from the 
vessel wall and enters circulating blood, it
.is called an embolus

27. The clot lodges in the circulatory 
system as the diameter of the vessels
decreases. This most commonly
occurs when the thrombus enters the
pulmonary vasculature, where it
interferes with blood flow to the lung
(. (a pulmonary embolus
Large pulmonary emboli can cause 
immediate death, but small thrombi
.may produce no clinical symptoms

28. Immobility promotes venous stasis, 
contributing to the development of
.DVT
When leg muscles are inactive, venous 
return to the heart decreases with
time the gravitational effect of the
supine position results in the
redistribution of body fluids, with a net
. decrease in venous return

29. Decreased Lung Expansion 
The immobilized client experiences 
greater -than-normal resistance to
breathing, resulting in under inflation of
the lungs and increased work of
.breathing
The immobile client, breathes less deeply 
and with greater effort. The supine client
must overcome two resistances that do
. not ordinarily work against breathing

30. First, the diaphragm ,second, the 
pressure of the bed against the chest
wall limits the client's chest
movement. Together, these factors
result in diminished depth of
. breathing
Because the immobilized client's 
activity level is less than normal, less
carbon dioxide is produced. This
results in a lower level of stimulation
for breathing, causing further

31. Decreased depth of breathing can result 
in the collapse of alveoli, which in turn,
hinders the exchange of oxygen and
carbon dioxide. This condition causes
alveolar collapse is known as
. atelectasis
In addition to limiting the lungs'ability 
to exchange gases, atelectasis
. predisposes the client to pneumonia
The client ability to cough deeply is 
often limited; thus, mucus may become
trapped in the lung, providing a rich
.medium for microbial growth

32. :Decreased Metabolic Rate 
The basal metabolic rate decreases 
. during immobility
Severely restricted activity affects the 
amount and pattern of production of
thyroid hormone, adrenocorticotropic
hormone, aldosterone, and insulin. It
.also alters drug metabolism

33. Negative Nitrogen Balance: In an active 
person, a balance exists between protein
. breakdown and protein synthesis
However, immobility raises the rate of protein 
breakdown, probably because of muscle
atrophy. A negative nitrogen balance results
when nitrogen excretion exceeds dietary
. intake
Anorexia:(loss of appetite) is common in 
. immobilized clients
Decreased metabolic rate is accompanied by 
decreased caloric need. Moreover, if the client
is confined to a healthcare facility, the
institutional food, eating in a supine position,
environmental factors, and psychological state

34. : Impaired Immunity 
The immune system is weakened 
. during immobility
Catabolism of immunoglobulin G 
doubles, significantly decreasing the
normal concentration of circulating
.antibodies
Leukocytes are less able to engulf and 
. destroy microorganisms
Lymphatic transport may be decreased 
as well when skeletal muscles are
.inactive

35. :Pressure Sores 
Pressure sores form when pressure 
exerted over an area of skin or
subcutaneous tissue exceeds the
pressure required for adequate blood
. to the area
Cells die because they do not receive 
oxygen and nutrients and because
. waste products accumulate

36. Pressure is usually concentrated on 
bony prominences but can occur
. anywhere that pressure is great
In the supine position, pressure is 
greatest over the back of the skull and
at the elbows, sacrum, ischial
. tuberosities, and heels
In the sitting position, the greatest 
pressure is at the ischial tuberosities
.and the sacrum

37. :Urinary Stasis 
The immobilized client may not heed the 
urge to void. Clients in institutional
settings may not want to bother the
nurse by asking for a bedpan. Some
clients try to void when they feel the need
but have difficulty relaxing the perineal
.muscles from the supine position
Delaying micturition causes urine to 
collect in the bladder. Chronic delay can
lead to overstretching of the detrusor
muscle in the bladder wall, permanent
changes in bladder tone, and long-term
consequences for normal voiding
.patterns

38. In the upright position, gravity 
encourages the continual flow of urine
from each renal pelvis into the
ureters, and from the ureters to the
. bladder
When a person is supine, the ureters 
are above the level of many renal
calyces, which means that urine must
flow upward against gravity to enter
.the ureters

39. :Urinary retention 
poses significant problems for the 
immobilized client. One problem,
urinary stasis, contributes to urinary
. tract infections and renal calculi
Bladder distention, another problem, 
leads to overflow incontinence, which is
embarrassing for the client and can
.contribute to skin breakdown

40. : Urinary Tract Infection 
Stagnant urine makes a good medium 
. for bacterial growth
Bladder distention can cause small tears 
in the delicate bladder mucosa, Which
contributed to the incidence of urinary
. tract infection
When the client experiences distention, 
catheterization may be necessary to
empty the bladder. With an of
catheterization comes the risk of
introducing pathogen and infection into

41. : Renal Calculi 
Urinary stasis and an increased serum 
calcium level promote the formation of renal
(. calculi (kidney stones
As serum calcium levels rise (the result of 
calcium loss from the bones ), the kidney
excretes more calcium. This raises urinary
calcium levels. Because calcium can
precipitate from solution to form crystals and
because stagnant urine encourages the
aggregation of crystals, renal calculi pose a
. significant problem
Dehydration, common tit the immobilized 
client, also increases the incidence of calculi
formation
Additionally, infection caused by some urea- 
splitting organisms makes the urine more
alkaline, which also promotes calculi

42. :Constipation 
Even in a healthy person, dietary changes, 
activity variations, or emotional stress
. affect normal bowel patterns
The immobilized client faces additional 
changes. Abdominal and perineal muscles
can be weakened by muscle atrophy,
making it more difficult for the client to
bear down and exert pressure to evacuate
. stool
As stool descends against the rectum, the 
person feels the stimulus to defecate. In an
upright posture, stool descends more
quickly into the rectal area, eliciting a
.strong stimulus
In the supine position, rectal filling is slow, 

43. The defecation reflex also can be affected if 
the person postpones defecation after
recognizing the stimulus to defecate. This
happens frequently in the immobilized client,
who may feel embarrassed or may need
. assist to use a bedpan
When a person delays defecation, fecal 
material increases in size and the intestine
absorbs more water from the feces, making
. stool passage even; more difficult
Dehydration, common in the immobile client, 
also can contribute to constipation. The
result may be fecal impaction (hard stool
contained in the rectum that cannot be
removed naturally by defecation). Often,
iquid stool seeps around the obstruction

44. Immobility can interfere with normal 
sleep patterns. Normal activity,
especially physical work, and aerobic
exercise produce a sense of fatigue that
helps the person fall asleep and obtain
. restful sleep
The immobilized client may doze 
frequently during the day, disrupting
. normal night time sleep patterns
The immobilized client must be, 
awakened frequently to be turned ,
monitored or given treatment and

45. Because immobility decreases freedom to 
interact normally with the environment, the
client receives less sensory information,
preoccupation with somatic complaints,
difficulty with time perception difficulty with
un-derstanding and following directions,
crying, and other emotional outbursts
. frequently occur
Contusion is common but reversible it normal 
sensory input returns. In severe cases,
sensory deprivation can occur, causing the
client to experience visual and auditory
.hallucinations
Pain may result from physiologic changes that 
occur with immobility. Joint stiffness,
pneumonia, pressure sores, thrombosis, and
emboli can contribute to discomfort. The
perception of pain also may intensify because

46. Changes in self-perception and self-concept 
come accompany functional motor impairment
. or immobility
Immobility contributes to a feeling of 
powerlessness, especially when the client
must depend on others. Motor impairment can
alter body image, especially if the impairment
results from loss of a body part. Self-concept
is altered when the client must depend on
devices such as crutches, wheelchairs, or
walkers. Problems with coordination can
cause embarrassment (eg, the client may
worry about appearing awkward or even
(. intoxicated
Altered body image can negatively impact self- 
esteem and lead to a feeling of lowered self-
.worth

47. Loss of mobility is not something the 
client chooses or desires. With trauma,
the loss occurs suddenly. In some
cases, it is permanent, requiring the
client to adapt to different functional
. abilities
Despite supportive social interactions 
with family and friends, immobilized
clients may spend many hours alone
. and are often bored or/ lonely
Depression, anger, and anxiety are 
.common

48. Lack of privacy, depression, fatigue, 
and physical limitations can
contribute to decreased sexual
. function
immobility may impede grooming 
activities that are often important in
. maintaining sexual identity
For some clients with long-term 
motor impairments, such as
paraplegia, sexual function may be
permanently altered, requiring the
client to learn new methods of sexual

49. Impaired mobility can severely restrict 
the client's ability to perform normal
daily activities, either temporarily or
.Permanently
Coordination and muscle Strength are 
necessary for eating, dressing, and
grooming. Usually, the nurse can show
the client ways to function successfully
. and despite physical limitations

50. Setting short-term, achievable goals 
and developing a long-range Plan in
collaboration with the healthcare
team (eg, physician, physical
therapist, occupational therapist,
psychologist, social worker) usually
. achieve the best results
For example, ambulatory physical 
therapy sessions may help the client
with mobility problems regain
.function and independence

52. Therapeutic positioning is used to prevent 
complications when mobility is limited. The
client may be placed in specific positions to
facilitate diagnostic tests or surgical
. intervention
Common positioning postures include prone 
(face on down), supine (lying on back), high
Fowler's (head of the bed elevated 80 to 90
degrees), semi-Fowler's (head of the bed
elevated 30 to 45 degrees), dorsal recumbent
(supine with legs flexed in an elevated
position), knee-chest position, Trendelenburg
(supine with head lower than feet), lateral or
side-lying position, and Sims' (semiprone be a
(. prone and side-lying position
Positions most commons used for the 
immobile client include supine, Fowler's,

53. Regardless of the specific position, 
general principles of body mechanics
should be used in any position change
: to
Maintain proper body alignment and 
. support a body parts
Avoid pressure, especially over body 
prominences, by adequately padding
. these areas
Such positioning aids as pillows, splints, 
footboards, and foam rubber or
.sheepskin protectors are helpful

54. Immobile clients should be turned 
and repositioned every 2 hours, More
. frequent turning may be needed
Significant factors include the amount 
of adipose tissue, skeletal structure,
underlying pathophysiology, comfort
level, skin condition, and level of
. mobility
Assessing for skin condition and signs 
of pressure is important in
determining the turning schedule.
Decreased capillary refill and
blanched or reddened areas indicate

55. Turning schedules should be 
incorporated in the plan of care and
posted at the bedside whether the
client is receiving care in the home, a
long-term care facility, or a hospital.
This helps ensure consistency of care
between different shifts and different
. caregivers
In extended-care facilities, where many 
clients require frequent position
changes, a specific rotation pattern may
be developed to ensure that various
.positions are used in an orderly fashion

56. Logrolling technique used for clients 
who have had surgery in injury
involving the back or spine
Instruct the client to keep his or her 
body as stiff as possible and to avoid
any sudden moves during the
procedure. A draw sheet can be helpful
in logrolling clients smoothly, especially
. if they are obese
When turning a client, place pillow 
between the legs. Leave the pillows in
place if the client remains in the side-

57. .Assess the client's abilities and limitations 
.Medicate client to provide optimal pain relief 
Organize environment, and request needed help to 
.ensure safety
Explain what you are going to do and how you 
.expect the client to help
Permit client to do as much as his or her 
.capabilities allow
Consider safety precautions (eg, lock wheels, use 
(.transfer belt
.Follow the principles of body mechanics 
.Keep movements smooth and rhythmic 
Prevent trauma (eg, friction against skin, pulling 
(.joints, grabbing muscles
Check client for proper body alignment and 
comfort, and provide client with call bell before
.leaving

59. Increased cardiac workload related to 
. prolonged bed rest
Potential for injury: deep vein 
thrombosis related to venous stasis,
hypecoagulability, and decreased
. muscle activity
Potential for injury: falls related to 
. orthostatic hypotension

60. Activity intolerance related to 
decreased muscle mass, tone, and
.strength
Impaired physical mobility related to 
muscle atrophy (contractures) and
(. limited joint mobility (ankylosis
Potential injury: pathologic fracture 
related to excessive bone
dmeineralizaiton (disuse
(. osteoporosis
Self-care deficit related to decreased 
muscle strength and decreased

61. Altered nutrition: less than body 
requirements related to negative
. nitrogen balance and anorexia
Altered nutrition: more than body 
requirements related to imbalance
between calories ingested and
. burned off
Fluid volume excess; dependent 
edema related to fluid shifts
(intravascular to interstitial
compartments) secondary to
. negative nitrogen balance

62. Altered bowel elimination: 
constipation related to decreased
. gastric motility and muscle tone
Altered nutrition: more than body 
requirements related to imbalance
between food intake and activity
(.(decreased energy expenditure

63. Alterations in comfort: acute pain 
related to inability to pass renal
. calculi
Potential for urinary tract infection 
related to urinary stasis and
. increase urinary alkalinity

64. Impaired skin integrity 
(. (pressure ulcer

65. Disturbance in self concept (body image, self 
esteem, personal identity) related to
. immobility and need to depend on others
Powerlessness related to increasing 
. dependency in basic self-care activities
Impaired social interaction related to 
. immobility
Altered thought processes: disorientation 
related to decreased stimulation to maintain
. orientation
Knowledge deficit related to decreased 
. motivation to learn
Ineffective individual coping related to 
prolonged bed rest and increasing activity
. intolerance
Altered sleep- wake pattern related to 
increased bed time/ napping and decreased